In Tanzania’s Mtwara and Lindi regions, a longstanding cooperation has drawn to a close
Saving mothers’ and newborn babies’ lives, increasing essential medicine supplies and providing a functioning social health protection scheme have been major challenges in Tanzania for a long time. Tanzanian-German development cooperation in the health sector which began almost three decades ago has tackled these and other issues, reaping promising results.
Since the early 1990s, the cooperation between German Development Cooperation and Tanzanian health sector partners has achieved important goals. Among them is the successful reduction of neonatal and maternal deaths, the increased availability of essential medicines and the establishment of a social health protection scheme for the informal sector. For the Mtwara and Lindi regions in south eastern Tanzania, this collaboration has now come to an end.
A festive closing event
Held on 25th and 26th February in Lindi and Mtwara respectively, senior GIZ advisor Dr Baltazar Ngoli of the Tanzanian – German Programme to Support Health spoke at the closing event in Lindi while senior GIZ advisor Mr Erick Msoffe spoke in Mtwara. In both Lindi and Mtwara, the respective Regional Commissioners attended as guests of honour. The celebrations were attended by the Regional Administrative Secretaries and Regional Medical Officers, while Dr Genchwele Makenge, the Regional Medical Officer in Lindi and Dr Silivia Makwe, the Regional Medical Officer in Mtwara outlined the successes of the programme through presentations.
A cooperation dating back to the early 1990s
The work with the Mtwara and Lindi regional health services started in the early 1990s. Initially, its focus was on clinical work in hospitals where German medical doctors helped organise capacity-building measures and provided technical advice.
Over the years, this changed. In successive programme phases, German development cooperation addressed hospital management and medical equipment maintenance capacities, introduced quality management of health services at primary and secondary levels, and supported the development of health information management systems.
Later, the German-supported programme provided assistance to health institutions in the Lindi and Mtwara regions for dealing with HIV / AIDS and in the prevention and management of sexually transmitted diseases. To achieve this, they cooperated with civil society organisations and established public-private partnerships, whilst continuing to drive quality improvement at regional and district hospital level, as well as developing human resources for health management.
According to Dr Sabine Flessenkaemper, head of programme, Tanzanian and German partners jointly achieved results that they can be proud of. ‘We have laid strong foundations for sustained development processes in both regions. Institutions and their staff are now in a very good position to independently continue on their paths.’
From mainly German to mainly Tanzanian project teams
Programme teams that initially comprised of mainly German experts gradually became much more mixed and eventually mainly Tanzanian. When the programme started Lindi’s Regional Medical Officer was Dr Mohamed Ali, while Mtwara’s Regional Medical Officer was Dr Sylvester Budeba while on the German side, the Health Programme Leader was Dr Bergis Schmidt-Ehry. ‘We thank all three of them because they laid the foundation for what became a very productive long-term cooperation between GIZ and Lindi and Mtwara regions,’ notes Dr Flessenkaemper.
Reducing newborn and maternal mortality
One of the programme’s most prominent recent achievements is a reduction of newborn deaths in health facilities, decreasing from 32 to 20 per 1,000 live births. At the same time fewer pregnant women died from direct pregnancy complications during childbirth in hospitals, with proportions decreasing from 2.4% to 1.1%.
‘We have saved so many newborn and children’s lives because of the support received from GIZ’, said Regional Medical Officer Dr Genchwele Makenge in Lindi. The improvement was in part due to the establishment of new neonatal care units in seven hospitals with essential equipment and working tools provided to the medical authorities, while all the staff providing care to newborns received further training.
Another factor which helped to reduce maternal deaths was the number of staff trained in managing obstetric emergencies in hospitals and health centres, said Dr Makenge. Between 2015 and 2019, the proportion of trained hospital staff rose from just 6% to 90%.
Ensuring access to healthcare through Community Health Funds
The cooperation also helped to strengthen the Community Health Fund – a social health protection scheme supported by both German financial cooperation through KfW development bank and German technical cooperation through GIZ. Through its Tumaini La Mama programme, KfW specifically supported the enrolment of pregnant women and their newborns. Overall, the Community Health Fund has enabled many people in the two regions to gain access to better quality health services.
Another programme goal was to improve the availability of essential medicines necessary to treat common diseases. In the two regions, the proportion of essential medication available increased from 51% to 92%, which in turn was one of the factors which contributed to higher customer satisfaction in district hospitals. In a survey conducted jointly by GIZ, the President’s Office Public Service Management, and the Regional Health Management Teams of Lindi, Mbeya, Mtwara and Tanga, customer satisfaction rose from 48% to 87% between 2016 and 2018.
Bringing local communities to the table
A key factor for the success and durability of the project was a strong working relationship between the project team, the Lindi and Mtwara Regional Health Management teams, the hospital staff and – very importantly – the local communities.
To ensure that citizens also participated in the health service planning processes so that their needs were accurately met, the health programme developed a score card mechanism through which citizens can engage in health planning and monitoring. 48 villages across all councils in the two regions used the score cards to involve their communities. Over 111,000 men, women and youth participated in this process between 2015 and 2018.
Time to raise the standards in other regions to the level set by Lindi and Mtwara
Looking back on the important results their cooperation achieved in Lindi and Mtwara, the governments of Tanzania and Germany have agreed that the focus should now shift to other regions where much still needs to be done. In the Tanga region, for example, newborn care needs to be established, and German-Tanzanian cooperation will focus on this challenge.
‘Tanzania is a big country, the needs are many,’ said regional commissioner Hon. Godfrey Zambi. ‘It is now time for other regions to be supported in order to rise to the level of quality health services we provide in Lindi and Mtwara’.
Just like the regional commissioner, Dr Flessenkaemper is certain that the health services in Lindi and Mtwara will continue on their promising paths. In the immediate future, Tanzania, like the rest of the word, faces another major challenge – the spread of coronavirus. ‘We are confident that the health workers we helped to train will do all they can to stem this tide. German development cooperation as a whole remains committed to helping African countries tackle this crisis.’